Abstract:
A 35 year old woman presents to her general
practitioner saying penetrative sex with her partner is
painful and that the pain has been progressively
increasing in severity over the past year. She describes
the pain as burning and located around the opening
of the vagina.
Vulvodynia is chronic vulval pain lasting more than
three months without an identifiable cause.1 2 It can
be classified as primary—present from the first
physical contact—or secondary, arising after an initial
pain-free period.2 The pain may be localised to a
specific area, such as the vestibule or clitoris, or
generalised, involving the entire vulva.2 The exact
mechanism of why vulvodynia occurs is not fully
understood and is likely multifactorial.
Multiple, large population based surveys in the US
estimate the lifetime prevalence of vulvodynia to be
10-28% in the general population.4 Qualitative studies
show themes of delayed diagnosis (in many cases
years), symptoms minimised by healthcare providers,
and a lack of awareness and understanding by health
professionals.3 4 For example, in interviews with 10
women aged 25 to 57 in the UK diagnosed with
vulvodynia, participants reported experiencing
disbelief, stigmatisation, and minimisation of their
symptoms by physicians.4 Interviews of eight women
aged 23 to 32 in Norway revealed similar patient
experiences.3
Vulvodynia, like other vulval pain, often affects
quality of life, causing extreme discomfort or pain
while wearing underwear, trousers, or while sitting.
It can also hinder intimate relationships,
gynaecological examinations and procedures, and
choice of menstrual products, and can negatively
impact daily activities such as going to work, school,
and recreational activities.
